Shih S L, Wang S T, Ma H L, Kao H C, Yu W K, Liu C L, Lo W H
Department of Orthopedics and Traumatology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1997 Aug;60(2):74-80.
Seat belt type injury of thoracolumbar spine is an uncommon injury characterized by disruption of the posterior elements of the spine. The fracture has long been treated conservatively, but progressive kyphotic deformity developed frequently.
From January, 1991 through December, 1992, 10 cases of seat belt type injury of the thoracolumbar spine were encountered at our hospital with an incidence of 8% in overall spinal fractures. Of these patients, eight patients were male and two were female, average age 30.7 years old. The causes included motor-vehicle accident in five patients, fall from height in four, and stricken by a falling electric pole in one. None of the victims of motor vehicle accidents wore seat belt. All of them received open reduction, posterior internal fixation and posterior fusion.
After follow-up for an average of 42.2 months, the average kyphotic angulation was 5.7 degrees. Back pain and function of these patients were all rated good. None of them suffered from neurologic deficit. One patient with breakage of transpedicular screws was encountered during follow-up, but there was no complaint.
In treating seat belt type injuries of spinal column, benefits of operation outweigh the risks. Besides, the clinical result is satisfactory and more aggressive surgical approach should be encouraged.
胸腰椎安全带型损伤是一种不常见的损伤，其特征是脊柱后部结构破坏。长期以来，这种骨折一直采用保守治疗，但经常会出现进行性后凸畸形。
1991年1月至1992年12月，我院共收治10例胸腰椎安全带型损伤患者，占脊柱骨折总数的8%。其中男性8例，女性2例，平均年龄30.7岁。致伤原因包括机动车事故5例，高处坠落4例，被倒下的电线杆砸伤1例。机动车事故受害者均未系安全带。所有患者均接受了切开复位、后路内固定及后路融合术。
平均随访42.2个月后，平均后凸角度为5.7度。这些患者的背痛和功能评分均为良好。无一例出现神经功能缺损。随访期间有1例患者椎弓根螺钉断裂，但无不适主诉。
在治疗脊柱安全带型损伤时，手术的益处大于风险。此外，临床效果满意，应鼓励采用更积极的手术方法。
